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CLASSIFICATION
Classification
EREFS (eosinophilic esophagitis)
Endoscopic findings of eosinophilic esophagitis (Edema / Rings / Exudates / Furrows / Stricture). Original total 0–8. Not a substitute for biopsy.
Classification overview
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Inflammatory
•
Edema · Decreased vascular markings
•
Exudates · White plaques or spots
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Furrows · Longitudinal furrows
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Fibrostenotic
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Rings · Fixed rings / trachealization
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Stricture · Focal narrowing
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Total
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Total · Sum 0–8
Inflammatory
Edema
Decreased vascular markings
Abe 2022, Fig. 2a, Not original, CC BY
Grade 0
Absent — distinct vascular markings
Grade 1
Present — loss of clarity or absence of vascular markings
Fibrostenotic
Rings
Fixed rings / trachealization
Abe 2022, Fig. 2b, Not original, CC BY
Grade 0
None
Grade 1
Mild — subtle circumferential ridges
Grade 2
Moderate — distinct rings that do not impair passage of a standard adult endoscope
Grade 3
Severe — distinct rings that do not permit passage of a diagnostic endoscope
Inflammatory
Exudates
White plaques or spots
Abe 2022, Fig. 2c, Not original, CC BY
Grade 0
None
Grade 1
Mild — lesions involving ≤10% of the esophageal surface area
Grade 2
Severe — lesions involving >10% of the esophageal surface area
Furrows
Longitudinal furrows
Abe 2022, Fig. 2d, Not original, CC BY
Grade 0
Absent
Grade 1
Present — vertical lines in the esophageal mucosa
Note: Later modifications sometimes grade furrows as 0 / mild / severe. This page uses the 2013 original 0–1.
Fibrostenotic
Stricture
Focal narrowing
Abe 2022, Fig. 2e, Not original, CC BY
Abe 2022, Fig. 2f, Not original, CC BY
Grade 0
Absent
Grade 1
Present
Total
Total
Sum 0–8
Range
Edema 0–1 + rings 0–3 + exudates 0–2 + furrows 0–1 + stricture 0–1 = 0–8
Domains
Inflammatory features: edema, exudates, and furrows. Fibrostenotic features: rings and stricture
Reporting
Use the highest score from the area of greatest involvement. Crepe-paper esophagus is a minor feature (absent or present).
Note: Biopsies from the distal and mid esophagus are still required. EREFS alone does not confirm the diagnosis.
Abe 2022, Fig. 2, Not original, CC BY
More reference figures
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Reference
Original article
Hirano I et al. Gut 2013;62:489-495
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Decision support only. Follow current guidelines and local protocols. Classification definitions and terminology follow the original publication language.